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Cited by 8Trauma and Emergency Care StudiesHealthcare Policy and ManagementGun Ownership and Violence Research

Impact of Medicaid expansion on young adult firearm and motor vehicle crash trauma patients.

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Ross, Michael R., Hurst, Philip M., Asti, Lindsey, Cooper, Jennifer N·2022·Surgery Open Science
DOI 10.1016/j.sopen.2022.01.004PMC PMC8881723
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Abstract

BACKGROUND: The Affordable Care Act Medicaid expansion has increased insurance coverage and reduced some disparities in care and outcomes among trauma patients, but its impact on subsets of trauma patients with particular mechanisms of injury are unclear. This study evaluated the association of the Affordable Care Act Medicaid expansion with insurance coverage, trauma care, and outcomes among young adults hospitalized for firearm- or motor vehicle crash-related injuries. MATERIALS AND METHODS: We used statewide hospital discharge data from 5 Medicaid expansion and 5 nonexpansion states to compare changes in insurance coverage and outcomes among firearm and motor vehicle crash trauma patients aged 19-44 from before (2011-2013) to after (2014-2017) Medicaid expansion. We examined difference in differences overall, by race/ethnicity, and by zip-code-level median income quartile. RESULTS: Medicaid expansion was associated with a decrease in the proportion of young adult motor vehicle crash and firearm trauma patients who were uninsured (motor vehicle crash: difference in differences - 12.7 percentage points, P < .001; firearm: difference in differences - 30.7 percentage points, P < .001). Medicaid expansion was also associated with increases in the percentage of patients discharged to any rehabilitation (motor vehicle crash: difference in differences 1.78 percentage points, P = .001; firearm: difference in differences 2.07 percentage points, P = .02) and inpatient rehabilitation (motor vehicle crash: difference in differences 1.21 percentage points, P = .001; firearm: difference in differences 1.58 percentage points, P = .002). Among patients with firearm injuries, Medicaid expansion was associated with a reduction in in-hospital mortality (difference in differences - 1.55 percentage points, P = .002). CONCLUSION: In its first 4 years, the Affordable Care Act Medicaid expansion increased insurance coverage and access to rehabilitation among young adults hospitalized for firearm- or motor vehicle crash-related injuries while reducing inpatient mortality among firearm trauma patients.

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  • Medicaid expansion has potential benefits including reduction of suicide rates and improving access to inpatient rehabilitation after acute hospitalization among those injured by firearms.

    “While Missouri expanded Medicaid in 2021, the high percentage of firearm injured patients without insurance is of great concern given the potential benefits of Medicaid expansion that include reduction of suicide rates and improving access to inpatient rehabilitation after acute hospitalization among those who are injured by firearms [20, 21].”

    From Firearm injuries in Missouri (2023) · cites this paper as [21]

    The Results section (page not provided) reports that Medicaid expansion was associated with increased discharge to inpatient rehabilitation among young adult firearm trauma patients. It does not report a reduction in suicide rates; its mortality finding concerns deaths in hospital among firearm trauma patients, which is a different outcome. (LLM, conf=0.88)

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Cited by

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Authors
Ross, M. R., Hurst, P. M., Asti, L., & Cooper, J. N.
Affiliations
  • The Ohio State University (US)
  • Abigail Wexner Research Institute (US)
  • Nationwide Children's Hospital (US)
Corresponding author
Cooper, Jennifer N
ORCID
Venue
Surgery Open Science
Publisher
Elsevier BV
Published
2022-04
Volume
8
Pages
9-19
ISSN
2589-8450 (ISSN-L)
DOI
10.1016/j.sopen.2022.01.004
PMC
PMC8881723
OpenAlex
W4210455081
Cited by
8
References
0
Citations by year
2026: 2 · 2025: 1 · 2024: 1 · 2023: 3 · 2022: 1
FWCI
1.66
Type
journal article
Language
en
Open access
Licence
Locations
  • Surgery Open Science (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
  • U.S. Department of Health and Human Services
  • North Carolina Department of Health and Human Services
  • Ohio State University
  • Florida Agency for Health Care Administration
  • Missouri Department of Health and Senior Services
  • National Institute on Minority Health and Health Disparities (R01MD013881)
Topics
  • Health Sciences › Medicine › Emergency Medicine › Trauma and Emergency Care Studies
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
  • Social Sciences › Health › Gun Ownership and Violence Research
Keywords
Medicaid expansion, Affordable Care Act, young adults, firearm injuries, traffic accidents, trauma care, insurance coverage, uninsured patients, in-hospital mortality, rehabilitation, health disparities, race and ethnicity, median income

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